Provider Demographics
NPI:1275675092
Name:THOMAS, JOEL R (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3831
Mailing Address - Country:US
Mailing Address - Phone:405-632-2323
Mailing Address - Fax:405-631-9315
Practice Address - Street 1:4625 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3831
Practice Address - Country:US
Practice Address - Phone:405-632-2323
Practice Address - Fax:405-631-9315
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25118207T00000X, 2085R0202X
MN1069202085R0202X
MN571182085R0202X
TXT46862085R0202X
AZ675412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275675092Medicaid